Pediatrics: PrepU: Chapter 14

A parent expresses concern about a 3-year-old child's pain while having blood drawn and asks the nurse what she can do to help the child. Which response by the nurse will be most beneficial?

"Focus on a story during the blood draw." Explanation:

The nurse has provided teaching of nonpharmacologic pain management to the parents of a 3-year-old child experiencing postoperative pain. Which comments by the parents indicate that the teaching was effective? Select all that apply.

"I'm not sure if I am imagining it, but I think my child seems to be in less pain when I rock her." "My child seems to cry a lot less with medical procedures if we are reading a book together." "One of the nurses blows bubbles with our child every time they are preparing to perform a procedure, then allows our child to do the same during the procedure. It really helps." "I try to remind our child to think about our dog at home. Our dog is like a big cuddle toy to our child."

The nurse is caring for a child who is experiencing postoperative pain after having undergone surgery several hours ago. The child's parent reports having taken meperidine for postoperative pain and wonders if that medication would be of benefit to the child. What response by the nurse is indicated?

"Meperidine is associated with toxicity issues in children and is usually avoided."

The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure?

"Pick your favorite Band-Aid and show me which arm to use." Allowing the child options related to the style of the Band-Aid and the extremity to use gives the child some control over the happenings. Offering a pinwheel is a distraction technique. Encouraging the parent to hold the child during the procedure promotes feelings of security. Encouraging the child or parents to ask questions facilitates communication.

The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?

"This can be taken with other medications we have at home that didn't require a prescription." The nurse must emphasize that the parents should carefully read labels of over-the-counter medications they already have or will purchase. Some may contain ibuprofen or other nonsteroidal anti-inflammatory drugs, and if given in conjunction with ibuprofen may lead to overdose. The other statements are correct.

The nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction?

"This medication should be taken on an empty stomach."

The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching?

"We should start the method after he feels pain."

The nurse is caring for a group of children who have had recent surgery. Which children will the nurse question to determine the location of their pain? Select all that apply.

3-year-old post tonsillectomy 4-year-old with a fractured tibia 5-year-old with sickle cell crisis 6-year-old with juvenile arthritis 7 year old post appendectomy DONT ASK THE 2 YEAR OLD WHO DOESNT UNDERSTAND WELL ENOUGH

A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is:

Acute referred pain Acute pain means sharp pain, as is the case in this scenario. It generally occurs abruptly after an injury. The pain of a pin prink is an example. Chronic pain is pain that lasts for a prolonged period or beyond the time span anticipated for healing. Referred pain is pain that is perceived at a site distant from its point of origin. In this case, the typical ice cream "brain freeze" is a headache that results from the contact of the cold ice cream with the digestive tract.

Visceral Explanation: Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.

After achieving a relaxed state, begin by guiding the 13-year-old client to image of walking down a sandy beach and collecting seashells, a favorite activity. Imagery begins with achieving a relaxed state. Then, the nurse guides the child to choose a favorite place. Imagery involves the use of imagination to create a mental picture. This image is positive and pleasurable. The child associates the image with colors, sounds, smells, or feelings. When using guided imagery, the nurse should not lead the child. The nurse lets the child become immersed in the personal image and take command of the experience. Guided imagery is not appropriate for preschool-age children and toddlers.

The nurse is caring for a burn client with orders for oral ibuprofen and morphine PRN to control pain. Which nursing interaction is the most beneficial for the nurse to implement for pain management?

Alternate these medications around the clock to diminish peaks and valleys in pain control.

A client comes to the clinic following an ankle injury. The nurse anticipates which therapeutic effect of heat if applied to injury site?

Capillaries dilate and edema reduces to the lower extremity

A 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have?

Conscious sedation Explanation: Conscious sedation refers to a state of depressed consciousness, usually obtained through IV analgesia therapy. The technique allows a child to be both pain-free and sedated for a procedure. The child is monitored throughout the process by a nurse. PCA is a pump that delivers pain medication and allows the client to receive medication via continuous infusion or bolus dose. General anesthesia means the client loses all reflexes. This is not necessary for an MRI and it would have to be administered and monitored via an anesthesiologist. An IM injection is painful and frightens the child. It is not necessary when oral and IV medications can be used.

A nurse is assessing the pain level of an infant. Which finding is not a typical physiologic indicator of pain?

Decreased heart rate

The nurse is aware of the special needs of children related to pain assessment. What is the priority for the nurse to consider when completing a pain assessment?

Developmental age of child Although all of the options are important for assessing pain in children, the priority to provide an appropriate pain assessment is knowing the developmental age of the child. The chronological and developmental ages may differ and care needs to be based on both, but the type of pain assessment tool used will be based on the developmental age. For children who are nonverbal the nurse needs to also consider the parent's statement of pain in the child.

A client is experiencing nociceptive pain as a result of a cancerous tumor of the bladder that has metastasized to other organs. What types of pain does the nurse expect the client to report?

Dull Deep aching Sharp stabbing

The nurse is assisting with the administration of the child's initial dose of parenteral opioids. Which action should the nurse take first?

Ensure naloxone is readily available When administering parenteral or epidural opioids, the nurse should always have naloxone readily available in order to reverse the opioids effects, should respiratory distress occur. Premedication with acetaminophen is not required with opioids. After administration, the nurse should continually assess for adverse reaction. The nurse should assess bowel sounds for decreased peristalsis after administration.

The nurse is preparing to assess the postsurgical pain level of a 6-year-old boy. The child has appeared unwilling or unable to accurately report his pain level. Which assessment tool is most appropriate for this child?

FLACC Behavioral scale The FLACC behavioral scale is a behavioral assessment tool that is useful in assessing a child's pain when the child is unable to report accurately his or her level of pain or discomfort and is reliable for children from age 2 months to 7 years. The preferred base age for the visual analog and numerical scales is 7 years . The FACES pain rating scale and Oucher pain rating scale are appropriate for children as young as 3; however, in this situation the FLACC is required due to the child's inability to report his level of pain.

The nurse is caring for a 12-year-old with cerebral palsy who is unable to communicate verbally. Which pain assessment tool is the most appropriate for the nurse to use when assessing pain in this client?

Face, leg, activity, cry, and consolability (FLACC) descriptors

A 5-year-old child has been admitted to the hospital and is going to have an IV started in the procedure room. Which instructions will be most helpful for the child and the parent?

Have the parent sing softly to the child during the procedure.

A nurse is applying EMLA as ordered. The nurse understands that EMLA is contraindicated in which situation?

Infants less than 12 months of age receiving methemoglobin-inducing agents EMLA is contraindicated in children less than 12 months who are receiving methemoglobin-inducing agents, such as sulfonamides, phenytoin, phenobarbital, and acetaminophen. Children with darker skin may require longer application times to ensure effectiveness. EMLA is not contraindicated for children less than 6 weeks of age or those undergoing venous cannulation or intramuscular injections.

The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?

Monitor the client's respiratory status.

The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priority following administration of the medication?

Monitor the client's respiratory status. It is priority for the nurse to assess the client's respiratory status after administering a narcotic medication. The nurse would reassess the client's pain level and document; however, these are not priority over monitoring the respiratory status. Playing a game may help distract the

The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated?

Observe for behavioral cues consistent with pain

The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made?

The child's nonverbal behaviors may indicate the presence of discomfort. Responses to pain can vary in children. A child of this age may present with vocal behaviors indicating pain. The child may be tearful or crying loudly. Being quiet can also signal pain.

An infant has a surgical repair of a congenital heart defect. In the immediate postoperative period, which scenarios best indicate that the infant is in pain? Select all that apply.

The infant appears restless and wrinkles the face. The best objective data that the infant is experiencing pain include a flexed body position, crying, a wrinkled face, a clenched fist or the inability to find a restful position. Crying when the parent picks up the infant potentially indicates pain or discomfort due to a position change. Physiological changes can also include changes in the infant's vital signs. Infant fatigue may cause a poor suck. Poor interaction may indicate fatigue or a potential bonding issue.

The nurse is caring for a term neonate suffering from meconium aspiration in the nursery. The nurse reviews orders for a peripherally inserted central catheter (PICC) line placement and intubation. Which statement demonstrates the nurse's knowledge of painful procedures as related to a neonate?

The newborn's pain pathway components are developed enough at birth to experience pain.

The nurse is caring for a client who has been diagnosed with a tumor in the small intestine that is pressing on the liver. Which type of pain does the nurse anticipate the client will complain of?

Visceral Explanation: Visceral pain is often produced by disease. It usually is diffuse and poorly localized and is described as a deep ache or sharp stabbing sensation that may be referred to other areas. Deep somatic pain typically involves the muscles, tendons, joints, fasciae, and bones and causes dull, aching, or cramping pain. Neuropathic pain usually results in burning, tingling, shooting, squeezing, or spasm-like pain. Chronic pain is defined as pain that continues past the expected point of healing for injured tissue.

The neonatal nurse is assisting the health care provider with a circumcision. Which pain relief method would be most beneficial?

anesthetic cream

A nurse is caring for a child who is grimacing but reports having no pain. What might be the rationale for a child being reluctant to express pain?

fearing getting a "shot" to relieve the pain

An adolescent is experiencing severe pain due to a sickle cell crisis. Which medication would be best for the nurse to administer?

hydromorphone For managing severe or acute pain, such as postoperative pain or the pain of a sickle cell crisis, opioids (e.g., morphine, oxycodone, and hydromorphone) are frequently prescribed. NSAIDS and acetylsalicylic acid would not help severe pain.

A new nurse is orienting to the newborn nursery and asks the nurse mentor why newborns were not considered to experience pain. How does the mentor explain the rationale used in the past that infants do not experience pain?

incomplete nerve myelination In the past, it was believed that infants do not feel pain because of incomplete myelination of peripheral nerves. Evidence-based practice has shown this not to be true because myelination is not necessary for pain perception. Immature nervous system, age, and assessment tools were not factors in prior beliefs that infants do not perceive pain.

Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects?

morphine

The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for?

respiratory depression, constipation, and pruritis

What are some negative effects that chronic pain can have on the pediatric population?

sleep disturbances, exhaustion, irritability, mood disturbances, and depression

Which statement is the goal of distraction techniques used to control pain?

to divert the child's attention away from the pain through controlled, purposeful behaviors

The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage?

uses words for pain such as owie, boo-boo, or hurt